Hypnotherapy Programme Registration 
Programme dates and times: 

Week 1 - Wednesday 21st February 6.30pm - 8.30pm 
Week 2 - Wednesday 28th February 6.30pm - 8.30pm
Week 3 - Wednesday 6th March 6.30om - 8.30pm

Address: 
Inner Guru THE HUB  2e Parkinson Road, Liverpool L9 1DL
Contact: 
tammy@catharticcounselling.com or 07768 347963 
Assessment 

This assessment is to be carried out by all individuals attending my group hypnotherapy programme. Unfortunately, there may be some people who will be medically exempt from taking part in hypnotherapy / hypnosis. 

Please answer the following questions honestly. 

Name *
Email *
Phone Number *
Do you suffer from any of the following symptoms?  *
Required
Have you been diagnosed with any mental health condition? *
Required
If yes, please explain what mental health conditions you have been diagnosed with? 

If no, please write in the comment box - N/A
 *
If yes, what medication are you currently taking for your mental health condition? 

If no, please write in the comment box - N/A
 *
Have you had or been diagnosed with psychosis? *
Required
Have you ever suffered a brain injury? *
Required
Do you have epilepsy? *
Required
Have you had hypnotherapy before? *
Required
I would like you to be as comfortable as possible, would you prefer? *
Required
*Please note 
Spaces are limited and allocated on a first come first serve basis. 
If you are lying down, please bring with you a yoga mat, pillow and blankets. 
If you are using a chair, please bring with you a pillow for head support and a blanket. 
In case you need more comfort, I have a selection of cushions and blankets that you can use. 
I consent to having this website store my submitted information so that Cathartic Counselling can process my place on the programme.  *
Required
If you are worried about whether you can take part in hypnotherapy / hypnosis please seek medical advice from your G.P. *
Required
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